Pediatric Gastroenterology, Hepatology & Nutrition最新文献

Purpose: This study aimed to evaluate the efficacy and safety of multi-matrix mesalazine in pediatric patients with ulcerative colitis (UC) in remission.

Methods: A multicenter, open-label, uncontrolled study was conducted in Japan, in which multi-matrix mesalazine 40 mg/kg was administered orally once daily for 48 weeks to 23 patients with UC in remission, aged <17 years. The primary endpoint was the nonoccurrence of rectal bleeding based on the Ulcerative Colitis Disease Activity Index (UC-DAI) score.

Results: The percentage of patients without rectal bleeding, based on the UC-DAI score in the full analysis set, was 73.9% (two-sided 95% confidence interval [CI]: 51.6%, 89.8%; n=17/23). The lower limit of the two-sided 95% CI exceeded the predetermined threshold of 50%, derived from placebo group data in previous clinical studies involving adult patients with UC. The incidence of adverse events (AEs) and study drug-related AEs was 87.0% (n=20/23) and 13.0% (n=3/23), respectively. No deaths were reported. None of the study drug-related AEs were severe or serious, nor did they lead to discontinuation of the study drug.

Conclusion: This study demonstrated the long-term efficacy of multi-matrix mesalazine in pediatric patients with UC in remission in Japan. No noteworthy safety concerns beyond those known to be associated with mesalazine were observed.

Purpose: This study aimed to evaluate a novel scoring system for the management of foreign body ingestion in children. A simple scoring system can greatly aid in clinical decision-making.

Methods: We developed a novel scoring system that considers several critical factors, including patient age, mood, and symptoms, as well as the characteristics of the ingested foreign body, such as its type, location, and size. This system was designed to help emergency department residents determine the most appropriate course of action. Based on their scores, the children were categorized into two classes: Class A (observation) and Class B (pediatrician consultation), and further subcategorized as Class B1 and B2.

Results: A total of 158 children were evaluated using this scoring system, with 79 confirmed cases of foreign body ingestion. Class A patients had a higher rate of successful observation and minimal intervention, whereas Class B patients had a higher rate of invasive treatment. Importantly, there were very few unnecessary invasive procedures, and the recommendations made by the scoring system were closely aligned with those made by a reference management algorithm.

Conclusion: Our novel scoring system demonstrates substantial potential for guiding residents in the appropriate management of pediatric foreign body ingestion, ensuring that children receive the most suitable level of care.

A significant increase in the incidence of pediatric inflammatory bowel disease (PIBD) across the Asia Pacific region has been observed. Countries in the region have diverse economies, with both developed and resource limited economies being represented. Literature from the region also varies, from reports on detailed epidemiological data and nuanced therapeutic outcomes derived from PIBD registries to case series from several geographic areas that have previously not reported on the condition. Through this position paper, we aimed to provide a comprehensive review of the challenges faced with diagnosing PIBD in the Asia Pacific region and offer pragmatic recommendations based on region-specific literature.

Purpose: Cyclic vomiting syndrome (CVS), is a diagnosis of exclusion within the disorders of the gut-brain interaction, consisting of recurrent vomiting episodes unexplained by another medical condition or its triggers. When a patient presents with a recurrent vomiting episode, a broad differential is considered. The aim of this systematic review is to provide a hierarchal differential diagnostic approach to children with known or possible recurrent vomiting.

Methods: This study followed the Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE and Scopus databases were searched using the following criteria: (1) Subjects aged 18 or under with vomiting spells classified as cyclic vomiting syndrome according to Rome IV criteria or equivalents for older publications and; (2) experimental, observational, or cross-sectional studies of 10 or more patients. A comprehensive literature search was performed with specific search criteria that included the diagnosis of cyclic vomiting syndrome. The results were analyzed using a Bayesian methodology to determine the rate estimates and 95% credible intervals for each disease.

Results: Seventeen studies (1,375 patients and 1,415 events) were recovered. 80.4% of the differential included: psychological stress (26.2%; 95% credible intervals [CredI], 24-28.5), infection (22%; 95% CredI, 19.9-24.2), motion sickness (19.3%; 95% CredI, 17.3-21.4) and migraine (12.9%; 95% CredI, 11.2-14.7). Surgical causes (4.8%; 95% CredI, 3.6-6.2) and mitochondrial diseases (0.4%; 95% CredI, 0.1-0.8) were uncommon.

Conclusion: Many triggers and diagnoses are associated with recurrent vomiting and CVS: psychological stress, infection, motion sickness, and migraine accounted for most cases. Serious surgical or metabolic diseases were less common.

Purpose: Congenital hepatic fibrosis (CHF) and/or autosomal recessive polycystic kidney disease (ARPKD) represent rare and complex clinical conditions in childhood. Diagnostic challenges often arise due to heterogeneity in clinical manifestations.

Methods: This study included pediatric patients diagnosed with CHF and/or ARPKD who were followed by the Pediatric Gastroenterology and Pediatric Nephrology Departments. Patient records were reviewed retrospectively.

Results: A total of 23 patients were included in the study. The median age of the cohort was 12.7±4.8 years, and the median age at diagnosis was 0.6±3.4 years. Thirteen patients had combined CHF and ARPKD, while 10 had isolated ARPKD. The diagnosis was incidental in 13 patients (56.5%), whereas five patients (21.7%) presented with an abdominal mass. Most patients had mutations in the polycystic kidney and hepatic disease 1 gene. Bilateral kidney enlargement and multiple millimetric cysts were identified in the majority of cases. Three patients required organ transplantation during follow-up. Two patients who underwent liver or kidney transplantation experienced no complications, whereas the patient who received combined liver and kidney transplantation developed kidney failure secondary to reflux nephropathy. Except for one patient who died in infancy, disease progression was generally mild in the cohort.

Conclusion: Although kidney involvement is often predominant, hepatic complications may develop over time, particularly in patients with combined disease. A collaborative, multidisciplinary approach is essential for effectively managing the complex manifestations of these ciliopathies.

Purpose: Endoscopic variceal hemostasis is a critical, life-saving intervention frequently performed by pediatric gastroenterologists. To ensure safe and effective practices, the Asian Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition Endoscopy Scientific Subcommittee developed a consensus-based position statement.

Methods: A comprehensive literature review was conducted with an emphasis on pediatric evidence. Nineteen draft statements were formulated and refined through electronic votes and virtual meetings. Statements with <80% agreement were revised until consensus was reached. Levels of evidence certainty were evaluated to support the final recommendations.

Results: Nineteen position statements, covering screening, acute management, and surgical options, were endorsed. Although noninvasive tools such as elastography and platelet-based indices may assist in risk stratification, endoscopy remains the diagnostic and therapeutic gold standard. Endoscopic variceal ligation was identified as the preferred modality for both prophylaxis and treatment in children ≥10 kg, outperforming sclerotherapy and non-selective beta-blockers. Standard acute management incorporates octreotide and restrictive transfusion strategies, with endoscopy performed within 24 hours. In refractory cases, the Meso-Rex stunt or transjugular intrahepatic portosystemic shunt may be considered depending on anatomy and available expertise.

Conclusion: These findings provide an evidence-based framework for the management of pediatric variceal bleeding. Individualized care is emphasized while highlighting the pressing need for high-quality pediatric studies to strengthen future recommendations.

Purpose: Excessive sodium intake in children can increase the risk of noncommunicable diseases in adulthood. Globally, children below 5 years of age consume approximately 2,000 mg of sodium daily, exceeding the recommended limit. However, studies on sodium intake among Indonesian children, especially those below 2 years of age, are limited. The aim of this study was to evaluate daily sodium intake and its associated risk factors.

Methods: In this cross-sectional study, the daily sodium intake and its associated risk factors were assessed in 85 healthy children aged 6-24 months in Jakarta between June and August 2024. Sodium intake was measured using urinary excretion (International Study on Salt and Blood Pressure formula), and dietary analysis was conducted using the Food Frequency Questionnaire. High sodium intake was defined per the Indonesian Pediatric Society guidelines.

Results: Results showed that 64% of children aged 6-11 months consumed over 1,200 mg/day of sodium (mean: 1,289.20±639.25), while 37% of children aged 12-24 months had high sodium intake (mean: 1,242.03±584.35). Family socioeconomic status significantly correlated with high sodium intake (r=0.176). Specific food types were identified as risk factors for excessive sodium consumption. In this study, it was concluded that almost all children aged 6-24 months had sodium levels above the recommended levels. Notably, all children aged 6-11 months had a higher sodium intake than approximately one-third of children aged 12-24 months.

Conclusion: These findings highlight the need for targeted interventions to reduce sodium intake among young children, especially among families with higher socioeconomic status.

Hirschsprung's disease (HD) and anorectal malformations (ARMs) are rare congenital conditions with an incidence of approximately 1 per 5,000 live births. While each condition presents unique challenges, their simultaneous occurrence is rare, complicating diagnosis and surgical management. A 6-year-old female with ARM, previously managed by colostomy and anorectoplasty, continued to experience stool passage issues. Further evaluation of colonic biopsies confirmed the diagnosis of aganglionosis and HD. A modified Duhamel procedure was performed to remove the aganglionic segment and restore bowel function. The postoperative care was uneventful, and the patient was discharged with normal bowel function. This case illustrates the diagnostic complexity of HD in patients with ARM in whom symptom overlap and diagnostic delays are common. Comprehensive evaluation and customized surgical management are essential along with long-term follow-up to monitor complications and improve quality of life.

Purpose: This study describes the clinical features, disease subtypes, laboratory findings, and outcomes of pediatric inflammatory bowel disease (IBD) in Jordan, with the aim of comparing regional and global trends.

Methods: We conducted a retrospective review of the medical records of patients diagnosed with IBD before the age of 18 years, who were followed up at the pediatric gastroenterology clinic at Jordan University Hospital between January 2015 and December 2022. The diagnoses were based on the revised Porto criteria.

Results: A total of 31 patients (61.3% male) were included in this study. The mean age at diagnosis was 8.7±4.75 years. Very early onset IBD (VEO-IBD) accounted for 38.7% of all cases. Crohn disease (51.6%) was more common than ulcerative colitis (UC) (29.0%) or unclassified IBD (19.4%). Diarrhea and abdominal pain were the most common symptoms. Steroids were used for remission induction in 90.3% of the cases, and %-aminosalicylic acid (5-ASA) was the most common maintenance therapy (48.4%). In CD patients, ileocolonic involvement (L3) was the most common (5, 29.4%), with non-stricturing, non-penetrating behavior (B1) in (10, 58.8%). Among UC patients, pancolitis was the predominant phenotype (3, 37.5%). C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were elevated in (19, 61.3%) patients, while ESR was elevated in (16, 51.6%) patients, respectively. Anemia was observed in more than half of the patients (18, 58.1%). Steroid remission was steroids in (28, 90.3%) patients. 5-ASA was the most common maintenance therapy used in our cohort (15, 48.4%). Biological therapy was used to (8, 25.8%) patients.

Conclusion: Crohn's was more prevalent than UC in the pediatric cohort. Limited access to biologics and frequent treatment escalations highlight the need for improved therapeutic options and the development of a national IBD registry.

Purpose: To evaluate the relationship between functional constipation (FC) and growth status in children using anthropometric indices (weight-for-height Z-score [WHZ] and height-for-age Z-score [HAZ]).

Methods: We conducted a retrospective cohort study at a pediatric primary care center in Jakarta, Indonesia, from December 2020 to December 2021. Medical records of 34 children with FC diagnosed using Rome IV criteria and 34 age- and sex-matched healthy controls were reviewed. Growth status was assessed using WHO WHZ and HAZ before and after polyethylene glycol treatment for at least six months. Data were analyzed using t-tests or nonparametric equivalents, with significance set at p<0.05.

Results: The mean age of our cohort was 3.17±2.11 years at baseline. For children with FC, the mean treatment duration was 17.15±7.22 months. Children with FC had lower WHZ at baseline than the control group (-0.21±0.73, compared to 0.62±0.85, p<0.001). Following treatment, those with FC had increased WHZ (0.18±1.19, p=0.028). No changes were observed in the HAZ before and after treatment (p>0.05).

Conclusion: FC in children is associated with the WHZ. The completion of FC treatment improved the WHZ in children compared with that at baseline. However, no association was identified between FC and HAZ before and after treatment completion.